COVID-19 Pre-Appointment Screening

The rendering physician will be informed of any patients who have responded positively to the below questions. Patients with a fever of 99.7 or greater will have their appointment cancelled. They will be given information for the CDC & information to schedule a telehealth appointment.

Have you done any international travel to China, Japan, South Korea, Italy or Iran - OR - domestic travel from New York, New Jersy or Connecticut in the last 15 days?

Yes.
If Yes, where? ____________________________

No

Have you been in close contact with anyone that has tested positive for - OR - with a presumed positive diagnosis (quarantined) of Coronavirus (COVID-19) within the last 15 days?

Yes

No

Have you developed the following symptoms in the past 15 days?

Extreme fatigue

Cough

Shortness of breath

Fever – Current Temperature ____________________________


All non-essential guests will be asked to wait in their cars in order to limit the number of persons within an enclosed area. Guests that are deemed essential for the patient visit is subject to the same pre-appointment screening.

Essential Guests ONLY – Patient requires guest for appointment

Have you done any international travel to China, Japan, South Korea, Italy or Iran - OR - domestic travel from New York, New Jersey or Connecticut in the last 15 days?

Yes.
If Yes, where? ____________________________

No

Have you been in close contact with anyone that has tested positive for - OR - with a presumed positive diagnosis (quarantined) of Coronavirus (COVID-19) within the last 15 days?

Yes

No

Have you developed the following symptoms in the past 15 days?

Extreme fatigue

Cough

Shortness of breath

Fever – Current Temperature ____________________________


Our Locations

(949) 722-7038

Physician Offices

Huntington Beach

19582 Beach Boulevard, Suite 306
Huntington Beach, CA 92648

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Irvine

16300 Sand Canyon Ave, Suite 400
Irvine, CA 92618

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Mission Viejo

South Orange County Orthopaedics, Inc.
26730 Crown Valley Pkwy
Mission Viejo, CA 92691

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Newport Beach

22 Corporate Plaza Drive
Newport Beach, CA 92660

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